mr-2021.md (2286B)
1 ## HPI 2 3 70F with chest pain, abdominal pain, and constipation. 4 5 2-3mo weight loss, night sweats. 6 7 2-3wk +perineal ?cyst, initially ttp and hurt to walk, but now nontender. 8 9 ~1wk constipation, BRB on TP. 10 11 +crampy LLQ pain 8/10, x3-4 days, improves with positioning (supine with head raised somewhat, 3-4 pillows). 12 13 +LUQ and left-sided chest pain x1-2 days, radiates to L arm, not related to exertion, lasts a few minutes. 14 15 16 ## PMSHx 17 - TVH-BSO for fibroids and endometriosis (~20y ago) 18 - hemorrhoids (no surgeries) 19 - s/p Moderna COVID vaccine (~4wk ago) 20 - utd on mammograms, colonoscopies, no deviations from regular schedule 21 22 ## SHx 23 - monogamous x45y, G2P2 sons, 6yo grandson, all healthy 24 - never smoker 25 - social EtOH, none this year 26 - previously secretary 27 - likes to DIY: painting, home crafts, gardening 28 29 ## FHx 30 - M GM: uterine cancer (~40yo) 31 - P GF: lung ca, unknown type (~70yo) 32 33 ## OP Meds 34 - duloxetine 60mg 35 - ASA 81mg 36 - melatonin 6mg 37 - no notable allergies 38 39 ## PE 40 - VS: wnl 41 - GEN: NAD 42 - HEENT: no LAD 43 - PULM: fine 44 - CV: fine 45 - ABD: NTND, +splenomegaly 46 - GYN: 0.5cm lesion R side of anterior perineum, NT, freely mobile 47 - NEURO: fine 48 49 ## Labs 50 - Hgb 12.7 51 - WBC 58.3 52 - 0 blasts 53 - 0 atypical lymphs 54 - + slight L shift 55 - Plt 490 56 - BMP grossly wnl (gluc 202) 57 - LFTs fine 58 - Trop <0.01 59 - urate 10.4 60 - phos 5.0 61 - LDH 330 62 - fibrinogen 355 63 64 ## Other studies 65 - EKG wnl 66 - CT-PE -ve 67 - CT a/p wwo 68 - +10x7cm pelvic mass (central/R adnexum, exerting mass effect on sigmoid colon) 69 - spleen ~20cm largest dimension w ?infarcts x2, 70 - L internal iliac vein filling defects c/w nonocclusive DVT 71 - PET/CT 72 - splenomegaly with diffusely increased uptake, diffuse FDG uptake of axial and appendicular skeleton, mild uptake of abdominal pelvic lymph nodes, and minimal to mild uptake in the pelvic mass. 73 74 ## Further notes on hospital course 75 - CEA 1.7 (wnl), CA-125 52 (-) 76 - urate 9.5 5d later w IVF, given rasburicase 3mg x1 -> urate 3.8 77 - phos similarly without movement, sevelamer eventually helpful 78 - pelvic mass bx: smooth muscle 79 - BMBx: hypercellular >90%, no blasts, +trilineage atypica > myeloid, MF-1 fibrosis. 80 - JAK2 -ve, BCR/ABL -ve 81 82 ## TLS 83 - laboratory vs clinical 84 - risk assessment 85 - rasburicase 86 - allopurinol 87 - when to expect 88 89 ## MDS/MPN overlap syndromes 90 - something profound